They reappeared two hours later, deep in conversation and clearly troubled. Helen, back with her paperwork again, looked up, smiled and carried on.
‘So what do you think we should tell him?’ Ross asked, reaching for the coffee-pot.
‘Hmm.’ Tom propped himself against Helen’s desk and shrugged. ‘I don’t know. What do you think the prognosis is?’
‘I should say he doesn’t have one,’ Ross said candidly, passing Tom a cup of coffee. ‘Helen?’
‘No, thanks. Who are you talking about?’
‘Ron Church—we’ve just done a sigmoidoscopy and he’s got very widespread CA colon and rectum—God knows how he’s been so symptom-free for so long.’
‘Perhaps he hasn’t,’ Tom said quietly. ‘Perhaps he just didn’t realise it was anything to worry about till he started passing blood.’
‘Yes, it’s the fresh blood that frightens people. A higher bleed will usually go unnoticed. Oh, hell. So, what would you tell him?’
Tom frowned thoughtfully. ‘That we found something that needs further investigation and removal? That he will have a colostomy, and that depending on what else we find he will need further surgery and possibly other treatment to alleviate symptoms. That it’s possible that relieving pain and preventing further distress is all we will be able to do.’
Ross regarded him steadily. ‘What if he says no?’
‘Then he’ll suffer unnecessarily, possibly intolerably. I’d do my best to talk him into it, even if I know that we can’t save him.’
‘Would you mention the word cancer at this stage?’
‘Maybe. I’d let him lead me on that.’
Ross nodded. ‘Fine. Would you like to go and talk to him now?’
Tom looked resigned. ‘If you think so, but I don’t know him—wouldn’t it be better if you gave him the news?’
Ross’s mouth lifted in a wry smile. ‘Now how did I know you’d say that?’ he murmured, and, putting his cup down, he left the room.
‘Poor chap.’
Tom looked at Helen quizzically. ‘Who, Ross?’
Helen laughed. ‘No, Mr Church. He seemed a nice man—he’s only in his forties, isn’t he?’
‘Yes—forty-six. God, Helen, it was unbelievable considering his lack of symptoms. He’s within a few days of perforating, I should say—if that.’
‘His wife’ll be shocked—she said this morning as she was leaving, “Oh, well, at least once they’ve done this you’ll know there’s nothing wrong and you’ll be able to stop being such a worrywart.” She’ll feel dreadful, I should think.’
‘I wonder,’ Tom said slowly, ‘if that’s why he hasn’t done anything until now? Although the bowel is notorious for not giving signals.’
‘Yes.’ Helen sighed. ‘How about the others?’
‘The endoscopies? Two duodenal ulcers and one narrow bile duct, probably due to scarring following an infection. No sign of any stones now, but Ross is going to operate and enlarge the duct if he can, and have a closer look. He might even link the gall bladder to the duodenum and bypass the bile duct—it looked pretty tight. We’ll have another look at the plates before we operate, I guess, but I doubt we’ll see anything new.’
‘Are they staying?’
‘Ron Church will be, I imagine, but the others will go out and come back in a few days or weeks—Mrs Tranter and her bile duct sooner, I suspect.’
Helen smiled teasingly at Tom. ‘Funny how it’s usually the men who get ulcers. It’s because you all bury your emotions and won’t talk to each other—everything piles up and becomes intolerable.’
A fleeting shadow crossed Tom’s face, and he straightened up and set the cup down on her desk.
‘Yes, very likely. Mind if I have a look at the post-ops?’
The sudden change in atmosphere was puzzling. What had she said? Had he taken her remarks as criticism? She hoped he wasn’t going to be all tetchy and theatrical—it would drive her mad.
‘Feel free,’ she offered.
Then his bleep squawked and with a muttered, ‘May I?’ he reached for the phone.
She listened as he talked to the A and E department, and then he cradled the receiver and straightened up. ‘Acute abdo in A and E—probably surgical.’
‘Who did you speak to?’
‘Chap called Jack Lawrence?’
‘The consultant—if he says it’s surgical, it’s surgical. I’ll get a bed ready. Once you’ve seen him, can you let me know if it’s an ITU job?’
He grinned. ‘Sure—and it’s a she. Will you tell the boss?’
She nodded. ‘You go on down—can you find the way?’
The grin widened slightly. ‘Just about, I expect. I’ll be in touch.’
She followed him out and with one of the junior nurses she prepared a bed for post-op in the side-ward nearest the nursing station where the patient could be observed continuously. Depending on the nature of the emergency, the patient would be specialled for the first few hours anyway if necessary, but a little extra supervision wouldn’t go amiss.
She watched for Ross and saw him coming out of the little side-ward reserved for the day cases, his face grave. She followed him into her office and watched as he poured another cup of coffee. ‘How is Mr Church?’ she asked him.
‘Unsurprised. He wants to tell his wife himself, and then I’ll talk to her after he’s seen her. Where’s Tom?’
‘He’s gone down to A and E—acute abdo. I’ve alerted Theatre and prepared a bed. I’m just waiting to hear more.’
Just then the phone rang and she scooped it up. ‘Surgical—oh, hello, Tom.’
‘Hi—look, it’s a woman, early twenties, looks like a burst appendix. Is Ross around?’
She handed the phone over, waited while Ross talked to Tom and then looked at him expectantly. ‘Well?’
‘I’ll go in with him but I think Tom can handle it—he’s very good, if his performance this morning is anything to go by.’
‘So why go in?’
Ross shrugged. ‘If it’s a real mess it might take two of us to clean her up—and anyway, I’d like to see him in action.’
They were in Theatre for nearly two hours with her, and when they came back to the ward Helen heard all about it.
‘Ghastly mess,’ Ross told her, reaching for the coffee. ‘Must have been festering for months. Abcesses all over the place, all sorts of gynae implications—she’s obviously had roaring pelvic inflammation for ages, poor kid.’
‘What did you do?’
Tom pulled a face. ‘What could we do? We cleaned her up as well as we could, repaired the damage and sewed her up again, but goodness knows how well she’ll recover. She’ll probably get an infective ileus, so don’t assume that just because she’s got bowel sounds she’s ready for food, OK? It would just be the healthy bowel above the paralysed section trying to overcome the obstruction in the paralysed loops.’
Helen smiled slightly. ‘Don’t worry, Dr Russell—I’m well trained. I’ll do nothing and give her nothing without instruction.’
Tom evidently picked up a slight reprimand because his face relaxed and